CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 7 9.750000 487.5000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 24.000000 600.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 5 35.000000 1750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 24.000000 1200.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 70.000000 35.0000 0.5000
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 16 315.750000 15787.5000 50.0000
Subtotal (Total Children Is Unduplicated) 26 479.500000 19910.0000 41.5224
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Total 479.500000 19910.0000 41.5224
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Number of Children (Unduplicated) With at Least One Service 26
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Center 01
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
76 479.500000 19910.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 76 479.500000 19910.0000 0.0000